JPWO2019194174A1 - Medical projector - Google Patents

Medical projector Download PDF

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JPWO2019194174A1
JPWO2019194174A1 JP2020512257A JP2020512257A JPWO2019194174A1 JP WO2019194174 A1 JPWO2019194174 A1 JP WO2019194174A1 JP 2020512257 A JP2020512257 A JP 2020512257A JP 2020512257 A JP2020512257 A JP 2020512257A JP WO2019194174 A1 JPWO2019194174 A1 JP WO2019194174A1
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window
projector
organ
medical
medical projector
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Inventor
悦朗 波多野
悦朗 波多野
隆士 新田
隆士 新田
智 瀬尾
智 瀬尾
勝之 中村
勝之 中村
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Kyoto University
Mitaka Kohki Co Ltd
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Kyoto University
Mitaka Kohki Co Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A61B90/35—Supports therefor
    • G—PHYSICS
    • G03—PHOTOGRAPHY; CINEMATOGRAPHY; ANALOGOUS TECHNIQUES USING WAVES OTHER THAN OPTICAL WAVES; ELECTROGRAPHY; HOLOGRAPHY
    • G03B—APPARATUS OR ARRANGEMENTS FOR TAKING PHOTOGRAPHS OR FOR PROJECTING OR VIEWING THEM; APPARATUS OR ARRANGEMENTS EMPLOYING ANALOGOUS TECHNIQUES USING WAVES OTHER THAN OPTICAL WAVES; ACCESSORIES THEREFOR
    • G03B21/00—Projectors or projection-type viewers; Accessories therefor
    • G03B21/14—Details

Abstract

医療用プロジェクター(18)の窓(29)の全周を取り囲む状態で複数の照明(27)が設けられ、前記照明の白色光(H)を臓器(G)に対して全方向から照射することができ、蛍光画像(B)がドクター(D)の手(22)により遮られても、いずれかの照明は前記臓器を明るく照らすことができるようにするとともに、前記照明が下面(21)よりも外側へ突出した状態で支持され、前記臓器に対する照明の前記白色光の入射角度(θ)が小さくなるように構成した。A plurality of lights (27) are provided so as to surround the entire circumference of the window (29) of the medical projector (18), and the white light (H) of the lights is applied to the organ (G) from all directions. Even if the fluorescent image (B) is obstructed by the hand (22) of the doctor (D), one of the lights can illuminate the organ brightly, and the light is from the lower surface (21). Is also supported in a state of protruding outward, and is configured so that the incident angle (θ) of the white light of the illumination on the organ becomes small.

Description

本発明は医療用プロジェクターに関する。 The present invention relates to a medical projector.

手術で使用されるカメラは術野の上部にスタンド装置で支持され、術野の蛍光を撮影してモニターに表示することができる。ドクターはモニターに表示された蛍光画像を参考にしながら手術を行うことができる。関連技術は日本国特許公開公報特開２０１７−６６２０号（特許文献１）に例示される。 The camera used in surgery is supported by a stand device above the surgical field, and the fluorescence of the surgical field can be captured and displayed on a monitor. The doctor can perform surgery while referring to the fluorescent image displayed on the monitor. Related techniques are exemplified in Japanese Patent Publication No. 2017-6620 (Patent Document 1).

近年ではカメラで撮影した蛍光画像をモニターに表示するのではなく、撮影した蛍光画像を可視画像化してプロジェクションマッピング技術により術野の臓器等に直接投影する医療用プロジェクターが開発されている。このような医療用プロジェクターは蛍光を確実に撮影するため、手術室の無影灯を消灯して使用されるが、投影画像自体が明るいため、投影画像の視認には全く支障がない。 In recent years, a medical projector has been developed in which a fluorescent image taken by a camera is not displayed on a monitor, but a fluorescent image taken is converted into a visible image and directly projected onto an organ in the surgical field by projection mapping technology. Such a medical projector is used by turning off the shadowless lamp in the operating room in order to reliably capture fluorescence, but since the projected image itself is bright, there is no problem in visually recognizing the projected image.

しかしながら、ドクターが投影画像を確認した後に手術を開始すると、術野を明るくしていた投影画像がメスを持つドクターの手に当たり、手術部位が手の陰となって暗くなるという課題が生じていた。 However, when the operation is started after the doctor confirms the projected image, the projected image that brightens the surgical field hits the doctor's hand holding the scalpel, and there is a problem that the surgical site becomes a shadow of the hand and becomes dark. ..

本発明によれば、投影画像がドクターの手により遮られても術野を明るく照らすことができる医療用プロジェクターを提供することができる。 According to the present invention, it is possible to provide a medical projector capable of brightly illuminating the surgical field even if the projected image is obstructed by the hand of a doctor.

本発明の第１の技術的側面によれば、下面に形成した窓より術野の蛍光を取り入れて撮影可能なカメラ部と、該カメラ部により撮影した蛍光画像を可視画像化して窓より術野に向けて投影するプロジェクター部を備えた医療用プロジェクターであって、前記窓の全周を取り囲む状態で複数の照明が設けられていることを特徴とする。 According to the first technical aspect of the present invention, a camera unit capable of taking in the fluorescence of the surgical field from a window formed on the lower surface and taking a picture, and a fluorescent image taken by the camera part are visualized and the surgical field is taken from the window. It is a medical projector provided with a projector unit that projects toward the window, and is characterized in that a plurality of lights are provided so as to surround the entire circumference of the window.

本発明の第２の技術的側面によれば、照明が下面によりも外側へ突出した状態で支持されていることを特徴とする。 According to the second technical aspect of the present invention, the illumination is supported in a state of being projected outward from the lower surface.

本発明の第３の技術的側面によれば、励起光照明が下面における窓の周囲に設けられている。 According to a third technical aspect of the present invention, excitation light illumination is provided around the window on the underside.

スタンド装置に支持された医療用プロジェクターを示す斜視図。A perspective view showing a medical projector supported by a stand device. スタンド装置に支持された医療用プロジェクターを示す側面図。A side view showing a medical projector supported by a stand device. 医療用プロジェクターの内部構造を示す説明図。Explanatory drawing which shows the internal structure of a medical projector. ドクターの手により投影画像が遮られた状態を示す図３相当の説明図。An explanatory view corresponding to FIG. 3 showing a state in which the projected image is blocked by the doctor's hand. 医療用プロジェクターを示す下面図。Bottom view showing a medical projector. 医療用プロジェクターを示す斜視図。A perspective view showing a medical projector. リング状ベアリングを示す分解斜視図。An exploded perspective view showing a ring bearing. リング状ベアリングを示す断面図。Sectional drawing which shows the ring-shaped bearing. 図５中矢示ＳＡ−ＳＡ線に沿う断面図。FIG. 5 is a cross-sectional view taken along the line SA-SA shown in the middle.

本発明の好適な実施形態を図１〜図９に基づいて説明する。以下において前後左右の方向性は図１に示された通りである。 A preferred embodiment of the present invention will be described with reference to FIGS. 1-9. In the following, the front-back and left-right directions are as shown in FIG.

手術室内のフロア上に設置されているスタンド装置１は、ベース上で水平方向に回転自在なスタンド本体２を備えている。スタンド本体２には、前アーム３及び後アーム４を含む平行リンク機構Ｒが、前アーム３の途中に設定された回転軸５を中心にして回転自在に支持されている。 The stand device 1 installed on the floor of the operating room includes a stand body 2 that can rotate horizontally on the base. A parallel link mechanism R including a front arm 3 and a rear arm 4 is rotatably supported on the stand body 2 about a rotation shaft 5 set in the middle of the front arm 3.

平行リンク機構Ｒの上辺は支持アーム６の後側部分により形成され、支持アーム６はそのまま前方へ延びている。平行リンク機構Ｒの下辺は下アーム７の前側部分により形成され、下アーム７はそのまま後方へ延び、後端にはカウンタウェイト８が取付けられている。 The upper side of the parallel link mechanism R is formed by the rear side portion of the support arm 6, and the support arm 6 extends forward as it is. The lower side of the parallel link mechanism R is formed by the front side portion of the lower arm 7, the lower arm 7 extends rearward as it is, and a counterweight 8 is attached to the rear end.

支持アーム６の先端部には、途中から先端側が二股状に分岐した保持アーム９が取付けられている。保持アーム９は支持アーム６の軸心に合致した第１回転軸Ｘを中心に回転自在に取付けられている。 A holding arm 9 whose tip side is bifurcated from the middle is attached to the tip of the support arm 6. The holding arm 9 is rotatably attached around a first rotating shaft X that matches the axis of the support arm 6.

保持アーム９の二股状に分岐した先端側の端部１０間にはリング状の円筒部１１が取付けられている。円筒部１１はその最大直径部分が、第１回転軸Ｘに直交する第２回転軸Ｙを中心にした状態で、端部１０に対して回転自在に取付けられている。 A ring-shaped cylindrical portion 11 is attached between the bifurcated end portions 10 of the holding arm 9 on the distal end side. The cylindrical portion 11 is rotatably attached to the end portion 10 with its maximum diameter portion centered on the second rotation axis Y orthogonal to the first rotation axis X.

円筒部１１の内面には複数の凸部１２が円周方向に沿って形成されている。この凸部１２上にリング状ベアリング１３が取付けられている。リング状ベアリング１３は、外輪１４と内輪１５との間に複数のコロ（転動体）１６を介在させた構造で、その外輪１４がネジ１７により凸部１２に固定されている。 A plurality of convex portions 12 are formed on the inner surface of the cylindrical portion 11 along the circumferential direction. A ring-shaped bearing 13 is mounted on the convex portion 12. The ring-shaped bearing 13 has a structure in which a plurality of rollers (rolling bodies) 16 are interposed between the outer ring 14 and the inner ring 15, and the outer ring 14 is fixed to the convex portion 12 by a screw 17.

リング状ベアリング１３の内部には医療用プロジェクター１８が配置されている。医療用プロジェクター１８は概略直方体で、その側面の周囲に６個の取付部品１９が固定されており、その先端部がリング状ベアリング１３の内輪１５に下側からネジ２０により固定されている。リング状ベアリング１３の中心軸Ｚは前記第１回転軸Ｘ及び第２回転軸Ｙと直交し、医療用プロジェクター１８はこの中心軸Ｚを中心に円筒部１１及び外輪１４に対して回転自在となる。 A medical projector 18 is arranged inside the ring-shaped bearing 13. The medical projector 18 is a substantially rectangular parallelepiped, and six mounting parts 19 are fixed around the side surface thereof, and the tip portion thereof is fixed to the inner ring 15 of the ring-shaped bearing 13 from below by a screw 20. The central axis Z of the ring-shaped bearing 13 is orthogonal to the first rotation axis X and the second rotation axis Y, and the medical projector 18 is rotatable about the central axis Z with respect to the cylindrical portion 11 and the outer ring 14. ..

医療用プロジェクター１８の下端部には操作ハンドル２６が左右にそれぞれ取付けられている。この操作ハンドル２６はスタンド装置１の各回転部における電磁クラッチや医療用プロジェクター１８自体を操作するためのものである。 Operation handles 26 are attached to the left and right sides of the lower end of the medical projector 18. The operation handle 26 is for operating the electromagnetic clutch in each rotating portion of the stand device 1 and the medical projector 18 itself.

医療用プロジェクター１８の側面部には下端周囲に７つの照明２７が異なる長さの支持バー２８により医療用プロジェクター１８から離れた状態で且つ円周状に並んだ状態で配置されている。 On the side surface of the medical projector 18, seven lights 27 are arranged around the lower end in a state of being separated from the medical projector 18 by support bars 28 having different lengths and arranged in a circumferential shape.

スタンド装置１によりドクターＤの頭部より高い位置に支持された医療用プロジェクター１８は患者Ｐの手術中の臓器Ｇから蛍光部分を撮影して、それを可視画像化してリアルタイムで臓器Ｇに投影するための装置である。医療用プロジェクター１８の下面２１には窓２９が形成され、その四方にはそれぞれ特定波長の励起光Ｅを発する励起光照明３０が設けられている。窓２９の周囲に励起光照明３０があるため、励起光Ｅを臓器Ｇに対してあらゆる方向から照射することができる。 The medical projector 18 supported by the stand device 1 at a position higher than the head of the doctor D captures a fluorescent portion from the organ G during the operation of the patient P, visualizes it, and projects it onto the organ G in real time. It is a device for. Windows 29 are formed on the lower surface 21 of the medical projector 18, and excitation light illuminations 30 that emit excitation light E having a specific wavelength are provided on each of the four sides. Since the excitation light illumination 30 is provided around the window 29, the excitation light E can be irradiated to the organ G from all directions.

医療用プロジェクター１８の内部には窓２９の真上に光を部分的に透過・反射する光分岐手段３１が設けられている。更に内部にはプロジェクター部３２とカメラ部３３が設けられている。カメラ部３３の内部には蛍光カメラ３４と可視光カメラ３５が設けられており、蛍光と可視光に分離する図示せぬ光学フィルタ手段も設けられている。 Inside the medical projector 18, an optical branching means 31 that partially transmits and reflects light is provided directly above the window 29. Further, a projector unit 32 and a camera unit 33 are provided inside. A fluorescence camera 34 and a visible light camera 35 are provided inside the camera unit 33, and an optical filter means (not shown) for separating fluorescence and visible light is also provided.

患者Ｐには予め人体に安全な蛍光試薬が投与される。手術室内の無影灯３６は基本的に消灯する。励起光照明３０から特定波長の励起光Ｅを手術部位の臓器Ｇに照射する。すると臓器Ｇを含む術野において、肉眼では見えない組織表面下の血管やリンパ管の流れ或いは腫瘍等が蛍光発光部Ｆとして発光する。その蛍光発光部Ｆからの蛍光を含む術野からの反射光Ａを窓２９から医療用プロジェクター１８の内部に取入れてカメラ部３３に導く。カメラ部３３では反射光Ａを蛍光と可視光に分離し、蛍光は蛍光カメラ３４で、可視光は可視光カメラ３５で撮影する。 Patient P is previously administered with a fluorescent reagent that is safe for the human body. The surgical light 36 in the operating room is basically turned off. The excitation light E of a specific wavelength is irradiated from the excitation light illumination 30 to the organ G at the surgical site. Then, in the surgical field including the organ G, the flow of blood vessels and lymph vessels under the surface of the tissue or the tumor, which cannot be seen with the naked eye, emits light as the fluorescence emitting part F. The reflected light A from the surgical field including the fluorescence from the fluorescence light emitting unit F is taken into the inside of the medical projector 18 through the window 29 and guided to the camera unit 33. The camera unit 33 separates the reflected light A into fluorescence and visible light, and the fluorescence is photographed by the fluorescence camera 34 and the visible light is photographed by the visible light camera 35.

蛍光カメラ３４で撮影された蛍光画像Ｂは可視画像化されてプロジェクター部３２へ送られ、プロジェクター部３２から光分岐手段３１を介して窓２９より臓器Ｇに投影される。蛍光画像Ｂが臓器Ｇにリアルタイムで投影されるプロジェクションマッピングとなる。リアルタイムの投影のため、臓器Ｇの変形や移動にも時差なく追従し、ドクターＤはその臓器Ｇに投影された蛍光画像Ｂを参考にして手術を行うことができる。 The fluorescence image B taken by the fluorescence camera 34 is converted into a visible image and sent to the projector unit 32, and is projected from the projector unit 32 to the organ G through the window 29 via the optical branching means 31. This is projection mapping in which the fluorescence image B is projected onto the organ G in real time. Since it is projected in real time, it follows the deformation and movement of the organ G without any time difference, and the doctor D can perform the operation with reference to the fluorescence image B projected on the organ G.

ドクターＤが投影された蛍光画像Ｂを確認した後に手術を開始すると、図４に示すように、投影された蛍光画像ＢがドクターＤの手２２に遮られて臓器Ｇに当たらない場合がある。その場合臓器Ｇが手２２の陰になるが、照明２７が窓２９の全周を取り囲む状態で設けられており、照明２７の白色光Ｈを臓器Ｇに対して全方向から照射しているため、いずれかの照明２７は臓器Ｇを明るく照らすことができる。 When the operation is started after the doctor D confirms the projected fluorescence image B, the projected fluorescence image B may be blocked by the doctor D's hand 22 and may not hit the organ G, as shown in FIG. In that case, the organ G is behind the hand 22, but the illumination 27 is provided so as to surround the entire circumference of the window 29, and the white light H of the illumination 27 is radiated to the organ G from all directions. , Any of the lights 27 can illuminate the organ G brightly.

しかも、照明２７が下面２１によりも外側へ突出した状態で支持されているため、臓器Ｇに対する照明２７の白色光Ｈは入射角度θが小さくなり、ドクターＤの手２２の下側に入り込んでより確実に臓器Ｇを照らすことができる。手術中は時々臓器Ｇから手２２を離し、再度臓器Ｇに蛍光画像Ｂを投影して確認しながら手術を進められる。 Moreover, since the illumination 27 is supported by the lower surface 21 in a state of protruding outward, the white light H of the illumination 27 with respect to the organ G has a small incident angle θ, and enters the lower side of the hand 22 of the doctor D. The organ G can be reliably illuminated. During the operation, the hand 22 is sometimes released from the organ G, and the operation can be performed while confirming by projecting the fluorescence image B on the organ G again.

手術中に医療用プロジェクター１８の投影方向を変更する場合は、操作ハンドル２６を握りながら操作することにより、スタンド装置１の回転部分の電磁クラッチをフリーにして、医療用プロジェクター１８を全体的に上下或いは前後左右に移動させることができる。そして医療用プロジェクター１８が、第１回転軸Ｘを中心に保持アーム９ごと回転し、第２回転軸Ｙを中心にリング状ベアリング１３ごと回転し、リング状ベアリング１３の中心軸Ｚを中心に回転するため、投影方向を任意に変更することができる。 When changing the projection direction of the medical projector 18 during surgery, the electromagnetic clutch of the rotating portion of the stand device 1 is released by operating while grasping the operation handle 26, and the medical projector 18 is moved up and down as a whole. Alternatively, it can be moved back and forth and left and right. Then, the medical projector 18 rotates around the first rotation axis X together with the holding arm 9, rotates around the second rotation axis Y together with the ring-shaped bearing 13, and rotates around the central axis Z of the ring-shaped bearing 13. Therefore, the projection direction can be changed arbitrarily.

本発明の第１の技術的側面によれば、医療用プロジェクターの窓の全周を取り囲む状態で複数の照明が設けられているため、照明の光を術野に対して全方向から照射することができ、投影画像がドクターの手により遮られても、いずれかの照明は術野を明るく照らすことができる。 According to the first technical aspect of the present invention, since a plurality of lights are provided so as to surround the entire circumference of the window of the medical projector, the light of the lights is applied to the surgical field from all directions. And even if the projected image is blocked by the doctor's hand, either lighting can illuminate the surgical field brightly.

本発明の第２の技術的側面によれば、照明が下面よりも外側へ突出した状態で支持されているため、術野に対する照明の光の入射角度が小さくなり、ドクターの手の下側に入り込んで術野をより確実に照らすことができる。 According to the second technical aspect of the present invention, since the illumination is supported in a state of protruding outward from the lower surface, the angle of incidence of the illumination light on the surgical field is reduced, and the illumination is placed under the doctor's hand. You can get in and illuminate the surgical field more reliably.

本発明の第３の技術的側面によれば、励起光照明が下面における窓の周囲に設けられているため、励起光も術野に対して全方向から照射することができる。 According to the third technical aspect of the present invention, since the excitation light illumination is provided around the window on the lower surface, the excitation light can also be irradiated to the surgical field from all directions.

（米国指定）
本国際特許出願は米国指定に関し、２０１８年４月３日に出願された日本国特許出願第２０１８−０７１３２６号について米国特許法第１１９条（ａ）に基づく優先権の利益を援用し、当該開示内容を引用する。(Designated by the United States)
Regarding the designation of the United States, this international patent application incorporates the benefit of priority under 35 USC 119 (a) for Japanese Patent Application No. 2018-071326 filed on April 3, 2018, and the disclosure thereof. Quote the content.

Claims (3)

下面に形成した窓より術野の蛍光を取り入れて撮影可能なカメラ部と、該カメラ部により撮影した蛍光画像を可視画像化して窓より術野に向けて投影するプロジェクター部を備えた医療用プロジェクターであって、
前記窓の全周を取り囲む状態で複数の照明が設けられていることを特徴とする医療用プロジェクター。A medical projector equipped with a camera unit that can take in the fluorescence of the surgical field from a window formed on the lower surface and take a picture, and a projector unit that visualizes the fluorescent image taken by the camera unit and projects it toward the surgical field from the window. And
A medical projector characterized in that a plurality of lights are provided so as to surround the entire circumference of the window. 照明が下面よりも窓を中心とした放射方向外側へ突出した状態で支持されていることを特徴とする請求項１記載の医療用プロジェクター。 The medical projector according to claim 1, wherein the illumination is supported in a state of protruding outward in the radial direction centered on the window from the lower surface. 複数の励起光照明が下面における窓の周囲に設けられていることを特徴とする請求項１又は請求項２記載の医療用プロジェクター。 The medical projector according to claim 1 or 2, wherein a plurality of excitation light illuminations are provided around a window on the lower surface.
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JPS51139190A (en) * 1975-05-28 1976-12-01 Yamada Iryo Shomei Kk Apparatus of focusing an enclosed multi-lamp type astral lamp
JPH0924053A (en) * 1995-07-12 1997-01-28 Fuji Photo Film Co Ltd Surgical operation support system
JP2009502377A (en) * 2005-08-02 2009-01-29 ベルヒトルト、ホールディング、ゲゼルシャフト、ミット、ベシュレンクテル、ハフツング Surgical lighting lamp
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